1. Psychological Factors Affecting Medical Condition and Psychosomatic medicine H.M.Zainie Hassan.A.R. dr SpKJ(K) Psychiatric Departemen Medical School Padjadjaran University/Hasan Sadikin Hospital Bandung.

2. History of Psychosomatic Medicine The field of psychiatry >50years. Greek words psyche ( breath, to breathe) and soma (body). The problem mind & body and how they relate has been considered by all ages. The power of suggestion in the best tradition of the doctor-patient relationship. Emphasize a holistic concept.

3. Spirituality and Religion strong religious beliefs,spiritual yearnings,prayer,devotional acts have positive influences on mental& physical health Bio(anatomical.struct rural molecular effects on biological functioning Social,cultural,familial influence einvironment Psychological,effects of psychodinamic,motivation,pers onality George Engel 1977

4. Stress Theory Walter Cannon( 1875-1945)stimulation of the autonomic nervous system,the sympathetic hypertension,tachycardia, increased cardiac output. Harold Wolff(1898-1952) gastrointestinal tract appeared to correlate with specipic emotional state. William Beaumont(1785-1853)blood flow to the stomach was influenced by emotions. Hans Selye(1907-1982) he called unpleasant stress distress.Stress requires adaptation.

6. Cardiovascular system(coronary heart disease) Behavioral risk factors (smoking overeating,physical inactivity,poor compliance with mangement of diabetes hypercholesterolemia,hypertension). Complications / comorbid; depression(15- 20%), anxiety(5-10%), delirium,cognitive disorders. High levels of anxiety- tripling of risk of sudden cardiac death. Hostility and type A Behavior pattern. The relation between a behavior pattern characterized by easily aroused anger, impatience, hostility, competitive striving, and time urgency.

7. Gastrointestinal system Peptic ulcer disease, psychological factors had a role in the production of ulcer vulnerability,mediated through the increased gastric acid secretion.Psycho social factors are involved in the clinical expression of symptoms, possibly by reducing immune responses, resulting in vulnerability to Helicobacter pylori infection. colitis Ulcerative, studies of patient with U C have shown a predominant of obsessive-compulsive traits.

8. Diabetes Mellitus Stres: 1. Releases sugar(liver)→glukosa  2. Adrenalin released→inhibits release the role of insulin → glukosa  acute stress→can exacerbate an already existing diabetic condition. Diabetic patients are unable to meet the rapid changes in insulin requirements resulting from continual stress.

9. Skins disorders Stress → 40% of all skin disorders. Stress→may be the cause of neurotic excoriation and dermatitis artefacta. Stress can exacerbate anogenital pruritus. Stress → can be precipitating or perfetuating factors → urticaria, acne rosacea,herpes simplex and eczema. stress → influence psoriasis by lowering the body’s resistance and general state of health.

10. The immune system Stress is first experienced → immune system  (enhanced) Long term stress →immune response cell mediated /humoral are supressed. Sustained stress→ cortisol&cortikosteroid  →metabolic process  →protein avaiable for formation of mature blood cells&antibodies↓.

11. Backaches & headache Physical& psychological. Continual stress,feeling of helplessness of individuals who do not know how to cope with the causes of stress. Individuals tension result in backaches and headaches suffering from such problems often neither eat a healthy diet nor exercise sufficiently,resulting in unhealthy life-style which in turn leads to more stress, more pain and more medication.

12. Asthma & hyperventilation syndrome  Attacks precipitated by stress,respiratory infection,allergy. Examine family dynamics especially when child is the patient. Look for over-protectiveness and to encourage appropriate independent activity. Psychological theories strong dependency and separation anxiety, asthma wheeze is suppressed cry for love and protection.  Hyperventilation syndrome; accompanies panic disorder,generalized anxiety disorder with asso- ciated hyperventilation, tachycardia, vasoconst riction. May be hazardous inpatients with coronary insufficiency.

13. References Saddock BJ,Sadock VA,Synopsys of Psychiatry,Behavioral Sciences/Clinical Psychiatry,ninth ed.2003,p.822-839.